1. ACUTE CARE REHABILITATION COMMUNITY

2. STROKE IS A NEUROVASCULAR CONDITION AFFECTING BLOOD VESSELS IN THE BRAIN

3.  ISCHEMIC STROKE – occlusion of a cerebral artery causing damage to that portion of the brain dependent on the blood supply from the affected vessel.  HEMORRHAGIC STROKE – blood leakage from a cerebral artery that damages adjacent brain tissue.

4.  CAROTID ARTERIES – supply the anterior portion of the brain – including most of the cerebrum.  VERTEBRAL ARTERIES – housed in the cervical vertebral column – they merge to form the basilar artery – supply the posterior portion of the brain – the cerebellum and brain stem.

5.  MID CEREBRAL ARTERY – the largest vessel branching off the internal carotid artery – the most common site of cerebral occlusion. The MCA feeds: ◦ Frontal Lobes ◦ Temporal Lobes ◦ Parietal Lobes ◦ Basal Ganglia ◦ Internal Capsule

6. The MCA has a main stem and several branches. Occlusion of the main stem affects the entire area of the brain supplied by the MCA. This distribution of the MCA is so large that a stroke of the main stem puts the victim at risk of death or severe disability.

7.  Hemiplegia (paralysis) of the contral lateral (opposite) side affecting the lower side of the face, the arm, the hand, less affecting the leg  Contra lateral sensory loss in the same area  Contra lateral homonymous hemaniopsia – visual field defects affecting the same half of the visual fields of both eyes

10.  Aphasia – partial or total loss of the ability to communicate through language  Expression – difficulty converting thoughts into language  Reception – difficulty understanding verbal and written language  Both – global aphasia  Paralysis on the right side of the body  Dysphagia

11.  Impaired thought process – information processing delays  Impaired voluntary motion – apraxia  Confusion between left and right – poor discrimination  Loss of right visual field – right hemaniopsia  Easily frustrated  Compulsiveness or slowness

12. Do not underestimate his ability to learn and communicate  Use other forms of communication if he cannot speak  Do not overestimate his understanding of speech and overload him with “static”  Do not shout – keep the message short and simple  Do not use special voices  Divide tasks into simple steps  Give much feedback and point out every indication of progress. It is better to give too much encouragement than too little.

13.  Unilateral neglect Decreased awareness or failure to attend to the left side  Lack of awareness or concerns about deficits  Paralysis on the left side of the body (hemiplegia or hemiparesis)  Excessive talking  Short attention span  Memory problems  Poor judgment

14.  Time disorientation  Loss of left field of vision (left hemaniopsia)  Unconscious of neglect – person and environment  Impaired abstract thinking – concrete thinking predominates – doesn’t get the joke  Emotional lability  Lack of interest and motivation – lethurgy  Acts without thinking - impulsivity

15.  Do not overestimate his abilities. Spatial deficits are difficult to spot.  Use verbal clues  Break tasks into small steps with much feedback  Watch to see what he can do safely, rather than taking his word for it  Minimize clutter around him  Anticipate falls

16. Anterior Cerebral Artery (ACA) branches off the Internal Carotid Artery and supplies the frontal and parietal lobes  Least commonly affected by strokes  Contral lateral leg weakness  Sensory loss

17. Posterior Cerebral Artery arises from the top of the Basilar Artery and supplies the medial occipital lobe and inferior and medial temporal lobes  Vision is the primary function of the occipital lobe  Visual defects – contra lateral hemaniopsia

18. Vertebal Artery – basilar stroke affect the cerebellum, brain stem or both  Cerebellar strokes impair balance and coordination – ataxia  Brain stem stroke – rare, with devastating symptoms Hemiparesis or Tetraplegia Sensory loss affecting either one or both sides of the body Double vision – diplopia Dysconjugate gaze Slurred speech Dysphagia Decrease level of consciousness

19.  HTN  Rupture Aneurysm  Arteriovenous Malformation  Cause same focal symptoms as ischemic stroke  Results in more pronounced neck pain  Headache- “The worst headache of my life”  Light intolerance  Nausea and vomiting  Impaired level of consciousness

21. 1. Medical necessity to be in an acute setting  Would benefit from daily doctor’s visit  Requires 24 hour nursing care 2. Capable of doing 3 hours of therapy a day 3. Has a rehab diagnosis that prevents them from returning to community living 4. Has a reasonable chance of returning to community living 5. We can reasonably document a significant change in function  Change from max to min assist transfers  Incontinent to continent  De-cannulize trach

22.  Daily Program That Includes:  3 hours of therapy with OP therapist  RN supervision of program  Group therapy with peers and psychologist  5-6 hours per day  Facilitates transition to community